Ebola – crisis and opportunity for curriculum reform

It was a hot mid-August afternoon. 50 passionate volunteers were sitting in a hall just above the radiology department at Connaught Hospital, west of Sierra Leone. They were mostly medical students, accompanied by a few doctors and pharmacists. Standing in front of the class were two guest speakers from Ministry of Health and Sanitation (MoHS). The word “Ebola” lingered in the classroom just as it haunted the whole country. Slide after slide, the volunteers learned more about the deadly disease. The training finished with each volunteer receiving a certificate, which was also a burden to bear – for they all pledged to do health interventions in the community to combat the outbreak. This marked the beginning of the KickEbolaOut campaign, and signaled an important milestone in efforts to scale up the education for health workforce in the country.

Nobody was prepared when Ebola arrived at West Africa and the result has been truly devastating. WHO acknowledged that the aggregate case load of Ebola could exceed 20,000 over the course of this emergency1. By 17th of October, the outbreak had caused 932 deaths among the 2977 confirmed cases in Sierra Leone2. The number of new cases being recorded is doubling every few weeks. At this rate, 10 people every hour will be infected with Ebola in the country before the end of October3.

Ebola continues to spread like a wild fire in the region with cases now appearing worldwide. Healthcare workers are at the frontline of this battle – but are they prepared? How can we ensure that health workforce education can prepare them to respond to future challenges such as infectious disease epidemics?

Learn fast and KickEbolaOut

At first, standing aside might have to be the option for students in the College of Medicine and Allied Health Sciences (COMAHS) at University of Sierra Leone, which is the only medical school in the country. Before the outbreak, Ebola was considered endemic in Central Africa and thus was not emphasized in the curriculum. Students have insufficient knowledge of prevention and control of infectious diseases. They also have little experience in health education in the community. Help was not possible from public health students studying at the Njala University which is three hours away by car. Long distances and the slow internet speed have made it difficult for students from the two universities to collaborate. With insufficient clinical and non-clinical knowledge, there seemed to be little the students could do.

This highlights the need to strengthen the capacity for countries to significantly scale-up the education for health workforce students in the face of Ebola and other rapidly emerging challenges.

Sierra Leone Medical Students’ Association (SLeMSA) decided to step up. It launched a campaign called KickEbolaOut (read the case study here) and organized the first training in mid-August. Experts from the MoHS taught student volunteers about the epidemiology, signs and symptoms, and management of the disease. A standard prevention guideline was introduced to the students. A member of SLeMSA even gave a presentation on the different chlorine preparations available in the local market, correct preparation of chlorine for hand washing, and its side effects. To better prepare the volunteers for what would happen in the field, different scenarios were simulated as part of problem-based learning and critical thinking. Furthermore, volunteers were taught on how to build rapport with community members while maintaining appropriate distance and avoiding handshakes.

Volunteers of KickEbolaOut are listening carefully to the presentation by the Health Education Department of Sierra Leone Ministry of Health and Sanitation.

Working in Freetown, Sierra Leone’s capital, was tough. Each encounter with residents poses a risk of infection; nonetheless, the team seized every opportunity to educate the passersby. Education materials had to be simple and rely on pictures to convey messages, because more than 50% of the adult population is illiterate4. A van carrying a public announcement system was their important tool. The volunteers also split up to visit homes, shops and market places. Knowing that there is no known effective treatment for Ebola yet, the volunteers strongly advocated for greater prevention awareness among the community.

The challenge, as the volunteers described, was the need to change habits and beliefs of the people. How could an old gentleman be convinced to change his diet, when bush meat has been the favorite food of many locals for years? How could the heart-broken family of a deceased Ebola victim be convinced to keep their distance, when touching dead bodies has been part of the burial rituals for generations? Some people believed Ebola was a hoax. Some people were so afraid of Ebola that they missed clinic appointments or simply lost faith in health services. Misbelief and distrust together with disease and poor health system is indeed a lethal mix.

Before the outbreak, seldom were the students put under such circumstances to reflect on the social determinants of health (SDH).

Students were enlightened and, through the community outreach, actually helped restore trust between the public and healthcare providers. This was out of the students’ expectation and is certainly something that these future health workers will never forget.

Volunteers introducing the prevention guidelines through the PA system on their van (Left) and face-to-face conversations with community members (Right). Establishment of rapport requires an understanding of local culture and people’s beliefs.

The spirit of this campaign is no less contagious than the virus itself. The global KickEbolaOut Working Group has been established to ally students from around the world. The group is raising funds for SLeMSA to continue their effort, as well as to undertake research and assessment in the field. With the extensive network of International Federation of Medical Students’ Associations (IFMSA), National Member Organizations are engaged in their online activities or to set up similar actions in their own countries, through this reaching a global scale of awareness.

Ebola is threatening to undo more than a decade of efforts to rebuild Sierra Leone after its civil war. The outbreak has ruthlessly exposed the weaknesses of the delicate health and education systems.

Reform in curricula of health professional education is warranted. For Sierra Leone, an opportunity for change is being brought forward by the King's Sierra Leone partnership, in which King’s College London is catalysing curriculum reform in COMAHS. The local government should continue to show political commitment and take the leadership.

Emergency preparedness of health workforce can be achieved by enriching the curriculum. To combat emerging diseases in the future, merely teaching about Ebola is not sufficient. General knowledge on infectious disease, including both clinical and public health aspects, should be integrated into the curriculum. For example, infection control, contact tracing and surveillance are important concepts that all health professionals should be well informed about. National contingency plans should be developed, implemented and taught to students.

Health workers should be equipped with a critical mind to address the social determinants of the epidemic. With it they can think beyond clinical settings, challenge harmful cultural practices, and advocate for better socioeconomic conditions in the community.

The role of blended and eLearning is emphasized in WHO guidelines for transforming and scaling up of health professionals’ education and training. The systematic review of eLearning in undergraduate health professionals’ education will help guide and implement eLearning strategies that also support an SDH approach.

There are pertinent and timely examples of how eLearning can be utilized. WHO recently provided a webinar on prevention of Ebola. SLeMSA also cooperates with Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice (CRIMEDIM), a close partner with IFMSA, to develop an educational mobile application. In addition, a Massive Open Online Course (MOOC) such as the newly launched HKUx Epidemics is cost-effective and favors self-paced learning. Yet the question remains: can the local schools and households provide the necessary equipment for all students to benefit from these opportunities?

Vaccine is a powerful weapon against Ebola. So is knowledge. So is education.

Every deceased patient in this outbreak is an appeal for action. Curriculum development is a dynamic process and should adapt to meet the evolving needs of the population. Along with it, the role of digital media should not be overlooked.

KickEbolaOut campaign exemplifies how students are rapidly mobilized to contribute to the Ebola response. IFMSA affirms that students are competent, active and constructive partners in the development and governance of medical educational systems6. They can synergize local and international efforts, demonstrating what can be achieved in today’s interconnected world.

Mr. Asad Naveed is a final-year medical student at the College of Medicine and Allied Health Sciences, University of Sierra Leone, and currently serves as president of Sierra Leone Medical Students’ Association (SLeMSA), a national member of IFMSA. Born in Pakistan, he has undergone secondary education and now tertiary education in Sierra Leone, with clinical rotations at King’s College Hospital, London. He is deeply involved in medical student activities as a student leader and organizer.